BEFORE THE DISTRICT FORUM: KURNOOL
Present: Sri K.V.H.Prasad, B.A., LL.B., President
And
Smt. C.Preethi, M.A., LL.B., Member
Friday the 20th day of April, 2007
C.C. No.142/2006
M. Mahabub Bee, W/o. M.Maqbul, Aged about 47 years, Muslim
R/o.H.No.18-75, Kothapeta Street, Atmakur, Kurnool District.
…Complainant
-Vs-
The Divisional Manager, M/s. The Oriental Insurance Company Limited,
Bhupal Complex, Kurnool.
…Opposite party
This complaint coming on this day for orders in the presence of Sri. M.Azmathulla, and K. Ravi Kumar Advocates, Kurnool for complainant, and Sri. D. Srinivasulu, Advocate, Kurnool for opposite party and stood over for consideration till this day, the Forum made the following:-
O R D E R
(As per Smt. C.Preethi, Member)
1. This consumer complaint of the complainant is filed U/S 12 of C.P. Act., seeking a direction on opposite parties to pay Rs.2,00,000/- with 12% interest per annum, Rs.50,000/- towards damages, costs of complaint and any other relief or reliefs which the complainant is entitled in the circumstances of the case.
2. The brief facts of the complainants case is that the complainants husband M.Maqbul has taken a Janata Personal Accidental Insurance policy bearing No.2004/11 and which commenced from 30-10-03, to 29-10-04 for assured sum of Rs.2,00,000/- and nominated the complainant as his nominee, while the policy was inforce the complainants husband M.Maqbul died on 22-10-04 due to accidental hit by donkey at Atmakur town. On 16-11-04 the complainant intimated the opposite party as to the death of the policy holder and submitted claim form dated:11-04-05 along with original policy copy and death certificate. On 11-8-05 the complainant got issued a registered letter requesting the opposite parties to settle the claim but there was no response. Hence, the complainant had to resort to the forum for redressal.
3. The complainant in support of her case relied on the following documents viz: (1) certified copy of death certificate of M.Maqbul issued by Grama Panchayat Atmakur, besides to the sworn affidavit of the complainant in reiteration of his complaint averments and the above document is marked as Ex.A1 for its appreciation in this case. The complainant caused interrogatories to the opposite parties and suitablely replied to the interrogatories caused by the opposite parties.
4. In pursuance to the notice of this forum as to this case of the complainant, the opposite party appeared through their standing counsel and contested the case by filling written version.
5. The written version of opposite party denies the complaint as not maintainable either in law or on facts. But admits the deceased Maqbul has taken an individual personal accident policy for Rs.2,00,000/- and nominated the complainant as his nominee. It further submits that after receipt of intimation of death of the policy holder claim form was dispatched to the complainant. As per terms and conditions of the policy the death must be immediately intimated but in this case the intimation was receive after delay of 27 days as after lapse of policy. Therefore the complainant was asked to explain the reason for the delay and asked to furnish F.I.R., Panchanama, Postmortem report, death certificate, legal heir certificate. On 22-11-04 the opposite party has appointed an advocate investigator to know the cause of death of the policy holder. As the complainant failed to return the claim form the opposite party again sent another claim form along with letter dated:12-8-05 requesting the complainant to return the filled claim form along with the above required documents. But the complainant returned the claim form with death certificate only and no document is filed to prove the accidental death and no explanation was given for the delay in intimating the death of the deceased. The advocate investigator also revealed that the deceased death was due to ill-health and not due to accidental hit by donkey. Hence, there is a wrongful claim under the policy and the age of the policy holder it also suspecting. Hence, there is no deficiency of service on part of opposite parties and seeks for the dismissal of complaint with costs.
6. In substantiation of their case the opposite parties relied on the following documents: Viz: (1)letter dated:17-11-04 of complainant addressed to opposite party (2) Letter dated:19-11-04 of opposite party to the complainant (3) letter dated:11-8-05 of complainant to opposite party (4) preliminary claim form (5) letter dated:22-11-04 of opposite party to advocate investigator (6) letter dated:12-8-05 of opposite party to complainant (7) investigation report dt:28-01-05 and (8) statement of complainant to the opposite party, besides to the sworn affidavit of the opposite party in reiteration of his written version averments in the above documents are marked as Ex.B1 to B8. The opposite party caused interrogatories to the complainant and suitablely replied to the interrogatories caused by the complainant.
7. Hence, the point for consideration is to what relief and complainant is entitled to alleging deficiency of service on part of opposite parties:?
8. It is case of the complainant that her husband Maqbul died 22-10-04 due to accidental hit by donkey and that the said Maqbul was covered under the Janata Personal Accident insurance policy issued by opposite parties. A claim vide Ex.B4 was submitted to the opposite party but the opposite party did not settle the claim but appointment and investigator vide Ex.B5 and the said investigator submitted his report vide Ex.B7 along with statement of complainant vide Ex.B8. The investigation revealed that the deceased that hit by a buffalos and not by a donkey, as per Ex.B8 statement of the complainant and hence the complainant is not entitled to any reliefs. The opposite party to substantiate the said report did not choose to file the affidavit of so called investigator to prove the report and the statement recorded during the investigation. There is no material on record to prove that the statement of the complainant in Ex.B8 was recorded during the investigation of the said investigator. Moreover the Ex.B8 says that the deceased was hit by buffalos even assuming for arguments sake that in the statement of the complainant there is inconsistency about the animal hit the deceased that will not make much difference as the facts remaining that the deceased received accidental injuries and died.
9. The perusal of dictionary meaning of accident it will be clear that any event which happens without any cause or is not expected to be caused in normal circumstances is covered under it. It is also as unfortunate event causing physical harm or damage caused by some unintentional act. Thus the event which happened in the present case was merely an accident. It is not routine or a normal course that the complainant was hit by a donkey. It does not occur in normal course of life. Thus the event which occur in the present case is merely by chance and is covered by the word ‘accident’. The word is to be given its normal meaning by which it is understood by common man. Even a common man will say that if such an event happens it is by chance accident and not a natural phenomenon occurring so often. Thus, the non payment of assured amount to the claimant on this ground is total baseless and devoid of any reasoning which has been adopted by the opposite parties.
10. The other contentions of the opposite parties is that the accident was not reported to the police and postmortem has not been done and therefore on the ground, they are justified in not paying the assured amount, does not sound sufficient, for it being and case of a person having hit by an animal (donkey) being not an offence punishable under any of the sections of Indian Penal Code or other penal laws and not being a crime. There is no necessity for reporting the matter to the police. Equally there is no compulsion for conducting any postmortem on the victim.
10. Therefore, in the absence of any rebuttal evidence placed by the opposite party it cannot be held the insured person has not met with an accident and filed a false case. Non production of F.I.R and postmortem report would not mean that death was not due to injuries received due to hit by a donkey. The opposite parties merely relied on the investigator report (Ex.B7), which is not support by the affidavit of the said investigator. Hence no credence can be given to the said report and hence, the said investigation report cannot be looked into nor acquire any confidence.
11. In such circumstances, in the absence of any evidence in rebuttal that the claim is false and the opposite parties in not making the payment of the assured amount merely on the basis of the report of the investigator that the deceased death as a the result of hit by buffalos which makes no difference and the opposite party is not justified in rejecting the claim of the complainant.
12. Having regard to over all consideration there is no hesitation to hold that the opposite parties have miserable failed to substantiate their contentions and the conduct of opposite party in not paying the assured amount is certainly amounting to deficiency of service and thereby entitling the complainant to the claimed amount in the complaint.
13. In the result, and in sum up of the above discussions the complaint is allowed directing the opposite party to pay to the complainant the policy amount under the policy of bearing No.2004/11 of the deceased Maqbul to the complainant with 9% interest from the date of filling of this complaint i.e, 19-10-2006 till this realization along with costs of Rs.2,000/- within a month of receipt of this order.
Dictated to the Stenographer transcribed by him, corrected and pronounced by us Open bench on this the 20th day of April, 2007.
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the Complainant: Nil For the Opposite Parties: Nil
List of Exhibits marked for the complainant:-
Ex.A1 Attested Xerox copy of Death Certificate of M.Maqbul issued by Gram
Panchayath, Atmakur.
List of Exhibits marked for the opposite party:-
Ex.B1 Letter, Dt:17-11-04 of complainant addressed to opposite party.
Ex.B2 Letter, Dt:19-11-04 of opposite party to complainant.
Ex.B3 Letter, Dt:11-8-2005 of complainant to opposite party.
Ex.B4 Preliminary claim form (Personal Accident Insurance) Dt:Nil.
Ex.B5 Letter, Dt:22-11-04 of opposite party to Advocate, Investigator.
Ex.B6 Letter, Dt:12-8-05 of opposite party to complainant.
Ex.B7 Investigation Report, Dt:28-1-2005 of Advocate Investigation addressed
to opposite party as to claim of accident Insurance policy
No.433100/2004/11 of deceased.
Ex.B8 Statement of complainant to the opposite party.
MEMBER PRESIDENT
Copy to:
1. M. Mahabub Bee, W/o. M.Maqbul, Aged about 47 years, Muslim
R/o. No.18-75, Kothapeta Street, Atmakur, Kurnool District.
2. M.Azmathulla, Advocate, Kurnool.
3. The Divisional Manager, M/s. The Oriental Insurance Company Limited,
Bhupal Complex, Kurnool.
4. D.Srinivasulu, Advocate, Kurnool.
Copy was made ready on:
Copy was dispatched on:
Copy was delivered to parties:
